Healthcare Provider Details

I. General information

NPI: 1821670423
Provider Name (Legal Business Name): RENITA WU NG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 DAVIS ST
SAN LEANDRO CA
94577-6923
US

IV. Provider business mailing address

777 DAVIS ST
SAN LEANDRO CA
94577-6923
US

V. Phone/Fax

Practice location:
  • Phone: 510-626-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A25285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: